Thursday, March 24, 2005

An invitation to commit...

In reading the various blogs regarding the Schiavo case, I have felt that there have been some unspoken background stands that some bloggers seem reluctant to "out". I would like to provide an opportunity to commit to specific, somewhat simplified questions, so that we may know what are the underlying assumptions of your other writing. I specifically invite Moon, Caleb, whoever the Anonymous writer from tNP may be if not Caleb, Brian, Paul, Derek, Christie...anyone who has blogged about this in this interconnected group, to answer these two questions, without dissembling:

1) If Terri Schiavo's own wishes could be known (for example, a credible document or living will were found), would you allow her to refuse placement of a feeding tube, if that were the only means to provide her with food and water? Think of this as a thought question, if you will...please no arguing about whether such a document could be credible now, or whether she could be fed by mouth. (Assume she can't be, because some people certainly can't be.) Assuming that she could foresee her current state, or its possibility, would you allow her the right to refuse tube feedings under these circumstances?

2) If you, yourself, were in her exact medical situation, excluding the current intrusion of the public, and even assuming your own family situation if you like, would you want the tube placed into yourself?

Here's my answer. 1) I believe that refusing the placement of a feeding tube is one of Terri's acceptable moral choices. I believe that she has the right to prescribe that no person take such liberties with her body as to insert a latex, or plastic, or metal appliance into her mouth or nose, much less cut a new hole into her abdomen, if she does not wish it, and understands at the time of making the decision that such a proscription will eventuate in her own death under these circumstances. 2) I would exercise this choice in my own case. I unequivocally would refuse the placement of this tube, were I in her condition. I can, at this time, understand her condition and can comprehend the possibility that various events could lead to my being someday in a similar state. Under those circumstances, I would not want the tube placed. To me, regarding myself and my own family, it isn't even a difficult question.

Please do commit here. I feel we will be able to better understand your reasoning on your blogs if we know how you stand on these two questions.


  1. Anonymous3:33 PM


    Joe, sure, discussing hypothetical situations can help, to an extent. But you have to leave Schiavo totally out of it if you want the thought experiment to work.

    So the simplified first question is: should a competent adult be allowed to refuse any and all medical treatment, including a tube? Answer: of course. But the decision can never be made from the standpoint of, "It's my life and I can do with it as I please so long as I don't hurt anyone." No man is his own, he belongs to the membership, and his decisions much account for that belonging.

    The second question is not a hypothetical because there is great dispute about the "exact medical condition." As a general rule, I dislike the medical profession (sorry Joe). I dislike getting medical treatment, and think hospitals and doctors usually succeed in making people sick rather than well. I am unlikely to want even relatively non-invasive treatments such as, say, cholesterol lowering medication, let alone more invasive stuff like feeding tubes and respirators.

    The Schiavo situation is fundamentally not about these issues: it is a conflict of allegiances. It is about the colonization of older traditional structures of social and political order such as family, church, village, caste, craft. It is about the disassociation of these relationships from the functional application of power in our national political and economic life, and in our individual moral aspirations. It is about the way in which power and responsibility, once exercised in a personalist, direct way within small, primarily personal relationships, has been usurped by rationalist contractualist systems which are ever increasing in their centralization, impersonality, and remoteness from order on a human scale.

    The medical and legal/political systems in this case are both invasive, and are invasive in ways that each buttresses the total power of the other based on a grossly individualistic understanding of what constitutes the good life; or a good life, as the case may be. And in so doing, the freedom of Schiavo’s community of care is being squeezed. Is it any wonder our social order carries such a pathological sense of alienation from meaning?

    Wendell Berry has a great story called “Fidelity” about a family who kidnaps an ailing father from a hospital that wants to keep him alive so he can be tenderly cared for until his allotted days pass. The point is neither “right to life” or “right to die.” Both sides are polluted with a mechanized/rationalized/individualistic/materialist understanding of what is at stake.

    - Caleb

  2. Joe,
    First Question- Yes I would honor Terri's request if her wishes were known to refuse a feeding tube. Similar to a point you made earlier I think God has placed within us systems which sustain us and when they fail we cease to live. Of course we have options of technology, therapy and so forth, but if these measures fail to rehabiliate us in the long term, I think it is reasonable to stop using them at some point. Otherwise it seems to me we are trying to procrastinate or resist an inevitable death(because of a fallen world), rather than allow a person to go in peace. BTW I think Caleb makes a good point following his repsonse to the first question.
    Second Question- My initial response is no. I would not want the tube placed in me under these circumstances.
    Christie G.

  3. 1) Yes
    2) No

    But, concerning number one. Perhaps a better way to think of it, a way that could at least sound better then the erroneous elevation of individual choice by liberalism would be for families, and perhaps church communities to discuss these things. If I sat down with my family, and my mom said, "Derek, if you were in a situation like Terry, I would like to be able to do anything we can to keep you alive," I think I would honor that and change my "living will." At least a family discussion seems a bit better than concluding that this is my individual choice. Just thinking...


  4. I stand with Caleb on this. Can she reject the treatment? Yes. Should she? Well, the waters would be muddied here, as Caleb points out, since her parents wish to care for her.

    Would I take a tube? I wouldn't want one. But, as Derek has pointed out, I wouldn't make this decision in the vacuum of my individuality.

  5. Thank you all for responding. Caleb (and Fr. Jape, whom you seem to quote without there a real Fr. Jape?)I don't even know what you are talking about, though it sounds very scary. I don't know how I, as a physician, or my colleagues, whom I know well, or my hospital, whose administrators are also well known to me...have anything to do with colonizing or centralizing anything. I am a part of my community, recognized by my patients, hailed in the mall, shown scars of wounds I repaired. When I interact with a patient, I provide information about options, and advice in thinking it all through. My wife and I have just been through the deaths of three parents and a sister in the last 5 years, in which role we were family and parts of the caring community for these loved ones, all of whom died in their beds at home with the full cooperation of the medical system and no interference from the government. Another sister has breast cancer, and has no complaints about the medical system, no perception of limitation of decisions, no sense of conspiracy to displace her own family and community relationships. I simply don't know what you're talking about. You seem to be living in a different world from mine.

    If you are simply lamenting the ascendancy of individualism, I concur, but I think I already see the seeds of a longing for community in the current 20-somethings. If you think we could care for the elderly in ways better than nursing homes, I also agree, but don't think there is any colonization going on (which implies an active encroachment)but rather an abdication of responsibility by families, requiring a taking-up of that responsibility by agencies private and public.
    What generates an intrusive medical system, in my experience, is precisely the kind of shennanigans we have seen in the activists involvement in the Schiavo case. As a result of this fiasco, there are likely to be additional regulations requiring review of these cases by committees either medical or judicial. You will not think these committees part of the community of caring you envision, and you will be correct, but they will have arisen not because of some conspiracy for power by the medical community, but because John
    Q Public thinks "there oughta be a law" regulating things which go on between a physician and his patient and family when life and death decisions are made.
    Contrary to what you may believe, most doctors just want to be left alone to see their patients, and most doctors want to help their patients, and most doctors are non-interventional and non-confrontational about families' and patients' wishes at the end of life, or regarding any aggressive treatment. We wish families were MORE involved, not less; many of our most distressing and time-consuming problems are "placement" issues in the face of non-supporting families and communities.
    If you have merely an anti-technical bias, which is suggested by your feeling toward medication per se, then I can't agree. In our grandparent's generation the most common cause of death was "apoplexy", or strokes due to uncontrolled hypertension. People died in their 50's of a disease which now can be controlled for a few cents a day with diuretics. I don't see this technology as intrusive, or as undermining communities.

  6. Anonymous11:45 AM

    Point of clarification: my comment here was posted ahead of Jape's commentary (he is quite "real," I assure you) which was posted ahead of the link given below.

    Joe, you don't understand because you have, at root, a liberal conception of the human person.

    Consider this an rx for the liberal soul:

    - Caleb

  7. Caleb, I was about to click on your link for the Rx, but thought I would first clarify, without benefit of reacting to your suggested site, what my conception of the human soul is, at this point. You can then help me by pointing out in what ways it is "liberal", (if that is even a pejorative term here...I don't know.)

    A human soul is a being descended from Adam that bears the image of God, is embodied in its initial and in its perfect state and, except for those biologically alive at the second coming of Christ, destined to die once at least (the second death being final rejection from God's presence into whatever state is depicted by the lake of fire.) The perfect human is Jesus Christ, resurrected. Insofar as we bear the image of God, God himself is the starting point in understanding our humanity. We are not primarily "rational" creatures as thought by Aristotle and Aquinas, though we clearly partake of the rational insofar as "rational" describes the rules God has placed upon this world, and we use reason as a tool for understanding (as we are, hopefully, doing here.) We are time-bound beings, and (I believe) probably shall always be, meaning that we experience reality in a sequence that gives meaning to our concepts of causality, motion and change. We were designed to live on earth, in bodies, in community with other humans, God, and (possibly) other spiritual beings like the angels. It is God's intention to build us up individually and in community into something that is called, variously, God's bride, God's temple, God's city, and Christ's body. Our entire existence, its complete course and end (telos)was/is known to God from eternity. He knows us as individuals...we each shall have "a name" known only to ourselves and to him, we each have various gifts that are to be used in the service of the Body. I do not have a soul, I am a soul. I do HAVE a body, or I may in some sense BE a body, but I don't believe I am ONLY a body, any more than Jesus, the perfect man, was ONLY a body. I do not believe that I simply emerge from the complexities of my physical neurological system, but rather emerge from the mind of God as one of his particular creations.

    Please explain what in this you regard as liberal. Or, if I have missed an aspect that you are specifically concerned with, please point it out and I will elaborate specifically on that aspect.

  8. OK. I just read Caleb's suggested article. I am a procedural liberal, no doubt about it. I am not, however, an ideological liberal. I have not been arguing that functionality or intellect defines a "life worth living"; I have, in fact, written against that.

  9. Anonymous3:07 PM

    "I am a procedural liberal, no doubt about it. I am not, however, an ideological liberal."

    See, here's the rub. You are attempting to hold a line in the sand that does not exist and therefore cannot be held. To be a procedural liberal is to be an ideological liberal. Ultimately, those in your shoes will suffer a divided soul. That is Cohen's point, and Jape has made the point rather expressly as well.

    More stern medication must be needed!

    Let's take the exact same issue out of the realm of Shiavo-mania, and see it at work in religious/political affairs:

    - Caleb

  10. The Eric Cohen article recommended by Caleb above is exceptional in my judgment – very valuable for me as a counter-account of the moral situation & a direction for further thinking. Thanks.

  11. Agreed. The question of "what would Terry want if she could speak?" is very problematic. The fear of being a burden might lead someone to reject (and this is a nice phrase used by Jape) "the community of care". But a morbid fear of death might lead one to demand the preservation of one's life at all costs. In either case, the concepts of choice and rights are morally inarticulate.

  12. 1. Yes and
    2. Yes

    And I disagree with Derek on this one. If I was in a state where I would never have any interaction with the environment or relationship to any degree with anyone, if I had no self-consciousness, if I had a completely flat EEG etc etc. Why would I not "go off the feed" and go die. I wouldn't let my parents or my wife or my six kids live under a false hope. It's tragic and horrible but, in such a case, it is not moral to try and hold on.
    It really comes down to one's view of the science and I have a VERY high view of the medical profession and science in general. Aren't ya glad we are talking in the abstract here.

  13. I didnt mean to say "go die" in the above. That sounded bad on re-read.

  14. Brad, I don't follow your last comments. You said "Yes" and "Yes", meaning that you believe Terry has the right to choose, and that you WOULD want the tube for yourself. However, the latter half of your comment seemed to presume you would NOT choose to be kept alive. I don't follow.